NPIMap

Individual provider Active NPI

Leenhapong Navaravong, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Provo, UT
National Provider Identifier
1396937363
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
8237582-1205 Issued in UT
Practice address
395 W Cougar Blvd
Provo, UT 84604-3311
Phone
(435) 357-4600
NPI assigned
Aug 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 8237582-1205 UT
Cardiovascular Disease Physician 207RC0000X 8237582-1205 UT
Cardiovascular Disease Physician 207RC0000X MD-42118 IA
Clinical Cardiac Electrophysiology Physician 207RC0001X 42118 IA
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Cardiac Electrophysiology Physician 207RC0001X 8237582-1205 UT Primary

Addresses

Primary practice location

395 W Cougar Blvd
Provo, UT 84604-3311

Mailing address

395 W Cougar Blvd
Provo, UT 84604-3311
Phone (435) 357-4600

Other identifiers 2

IdentifierTypeStateIssuer
1396937363MedicaidIA
P01437247OtherIARR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lnavaravong50289@direct.med.utah.edu Direct UNIVERSITY OF UTAH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, NV, WY3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190603001417 UT Practitioner - Cardiac Electrophysiology 3779715859 Reassigns benefits to 3 organizations
I20201019003081 NV Practitioner - Cardiac Electrophysiology 3779715859 Reassigns benefits to 1 organization
I20201207000608 WY Practitioner - Cardiac Electrophysiology 3779715859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

98 N 1100
Suite 302
American Fork, UT 84003-2947
Phone (801) 357-4600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-42118IAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health Services Inc CurrentSince Feb 25, 2024 Accepting new patients
Tooele Clinic Corp Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Ihc Health Services, Inc. CurrentSince Feb 25, 2024 Accepting new patients
University of Utah Adult Services Clinical Cardiac Electrophysiology Current Accepting new patients
University of Utah Adult Services Cardiovascular Disease CurrentSince Oct 4, 2020 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince May 3, 2019 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services Cardiovascular Disease CurrentSince Sep 1, 2020 Accepting new patients
University of Utah Adult Services CurrentSince May 3, 2019 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

247 Bluffs Ave
Ste 102
Elko, NV 89801
Phone (775) 369-2799

350 Falcon Ridge Pkwy
Ste 104
Mesquite, NV 89027
Phone (435) 673-3556

98 N 1100 E
Ste 302
American Fork, UT 84003
Phone (801) 357-7081

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

380 E 1500 S
Ste 202
Heber City, UT 84032
Phone (435) 657-4600

395 W Cougar Blvd
Provo, UT 84604
Phone (801) 357-4141

1000 N Main St
Ste B
Richfield, UT 84701
Phone (435) 289-2167

1950 Circle of Hope Dr
Slc, UT 84112
Phone (801) 585-0100

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

819 E Market Place Dr
Spanish Fork, UT 84660
Phone (385) 344-6600

2055 N Main St
Tooele, UT 84074
Phone (435) 843-3600

2321 N 400 E
Ste 300
Tooele, UT 84074
Phone (435) 833-9180

1200 College Dr
Rock Springs, WY 82901
Phone (307) 352-8352

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1396937363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "435-357-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043311",
            "telephone_number": "435-357-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAVARAVONG",
        "first_name": "LEENHAPONG",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "8237582-1205",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "UT",
            "license": "8237582-1205",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IA",
            "license": "MD-42118",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IA",
            "license": "42118",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "UT",
            "license": "8237582-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396937363",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01437247",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnavaravong50289@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.